Provider Demographics
NPI:1649572264
Name:FANJOY, MICHAEL (LPC, CAADC, CCS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:FANJOY
Suffix:
Gender:M
Credentials:LPC, CAADC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 TEEN CHALLENGE RD
Mailing Address - Street 2:
Mailing Address - City:REHRERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:19550-5000
Mailing Address - Country:US
Mailing Address - Phone:717-933-2805
Mailing Address - Fax:610-644-4066
Practice Address - Street 1:33 TEEN CHALLENGE RD
Practice Address - Street 2:
Practice Address - City:REHRERSBURG
Practice Address - State:PA
Practice Address - Zip Code:19550-5000
Practice Address - Country:US
Practice Address - Phone:717-933-2805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
PAPC009294101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPC009294OtherPA STATE LICENSE